The subject invention relates to a surgical stapling apparatus for suturing skin with deformable staples. More specifically, the subject invention discloses a stapler which is relatively simple in construction and permits the release of a staple at any point in the closure operation. In addition, the structure of the subject stapler substantially inhibits jamming.
In most surgical procedures, suturing of incisions or wounds is required. For many years, suturing was accomplished using filiment-type stitches which are individually tied. As can be appreciated, surgical procedures which require a large number of individually tied sutures take a considerable amount of time. It is well known that minimizing the duration of an operation is highly desirable due to the inherent risks of anesthesia.
Accordingly, in the prior art there has been developed surgical staplers which utilize deformable metal staples in place of filiment-type sutures. The advantage of the surgical staplers lies essentially in their fast operational speed enabling the duration of the surgical procedure to be substantially reduced. Examples of some prior art surgical staplers can be found in U.S. Pat. Nos. 3,889,683, issued June 17, 1975 to Kapitanov et al; 4,162,678, issued July 31, 1979 to Fedotov et al; 4,198,982, issued Apr. 22, 1980 to Fortner et al; and 4,216,890, issued Aug. 12, 1980 to Akopov et al.
The above cited patents disclose surgical staplers which are particularly suited for suturing internal organs. Examples of prior art staplers which are more particularly suited to the suturing of skin or fascia can be found in U.S. Pat. Nos. 4,127,227, issued Nov. 28, 1978 to Green, and 4,179,057, issued Dec. 18, 1979 to Becht et al. In a suturing operation and in particular skin suturing, the manner of joining the skin is particularly critical. More specifically, when closing an incision, it is desirable to draw the opposed edges of the skin into abutting contact. As opposed to overlapping the edges or leaving a space therebetween, bringing them into abutting contact promotes healing and minimizes scarring. Suturing with a prior art skin stapler, wherein a staple is clinched causes the skin to be drawn together a fixed amount assuming the skin is sufficiently loose. Thus, in order to achieve the desired abutting configuration, it is necessary that the initial separation, between the edges of the skin be regulated prior to the start of the clinching operation. Stated differently, the initial separation between the edges of the incision must correspond to the amount which the apparatus will draw the skin together.
As can be appreciated, during an operation, the rapid regulation of the separation between the edges of the incision, prior to suturing, may be difficult to achieve. Accordingly, it would be desirable to provide a surgical stapling apparatus which will effectively operate without precisely regulating the separation between opposed edges of an incision.
This object is achieved in the subject invention by providing a unique skin suturing apparatus wherein the clinching of the staple can be halted at any point in the clinching operation. More specifically, during the stapling operation, when the edges of the incision have been drawn together to achieve the desired abutting configuration, the anvil can be retracted releasing the staple in a partially clinched condition.
In the prior art a variety of staplers are known that are primarily intended for use with paper goods, and which incorporate a retractable anvil. Two examples of prior art stapling devices having retractable anvils can be found in U.S. Pat. Nos. 3,917,145, issued Nov. 4, 1975 to Graf et al and 4,013,206, issued Mar. 22, 1977 to Lemos. Both of the patents disclose devices wherein the retraction of the anvil is dependent upon the movement of the driver blade and are incapable of ejecting a partially clinched staple.
Another example of a prior art stapler can be found in U.S. Pat. No. 1,945,377, issued Jan. 30, 1934 to Posnack. The device in Posnack, primarily intended for use with paper goods, includes an embodiment having a retractable anvil which may be operated independent of the driver blade. The Posnack device includes a slidable anvil mounted at the base thereof. A handle may be provided which is pivotally mounted for rotational movement in conjunction with a cam. The cam is in turn, in operational contact with a pivotally mounted anvil actuator. The anvil actuator includes an arm which is in contact with a pin connected to the anvil. In operation, the handle which projects outwardly from the front of the apparatus, is lifted, causing the rotation of the cam which in turn moves the anvil actuator in order to retract the anvil. While the mechanism disclosed in Posnack is intended to be utilized at the end of the drive stroke, it appears that the mechanism could be actuated at an intermediate point to halt the clinching action and release the staple. However, it is clear that the mechanism in Posnack has shortcomings which render it undesirable for use in a surgical stapling apparatus. For example, the anvil mechanism in Posnack is disposed at the base of the apparatus and therefore would retract along the length, and possibly within, the incision. Clearly, this could interfere with the suturing operation and could affect the sterility of the procedure. In addition, due to the arrangement of the pivotally connected handle, which projects outwardly from the front of the device, and must be rotated, it is apparent that the apparatus requires two hands for its operation. More particularly, while one of the surgeon's hands is utilized to actuate the downward movement of the driver blade, his other hand would be required to rotate the handle in order to release the staple.
Accordingly, it is an object of the subject invention to provide a new and improved surgical stapler which is relatively simple in construction and permits the variable clinching of staples.
It is another object of the subject invention to provide a new and improved surgical stapler which can be readily operated with one hand.
It is a further object of the subject invention to provide a new and improved surgical stapler having a retractable anvil which pivots immediately away from the patient's skin surface.
It is still another object of the subject invention to provide a new and improved surgical stapler which includes a means to prevent clogging of staples in the drive track.